Our Summary

This video tutorial shows our method for safely removing the upper left portion of the lung and nearby lymph nodes in patients with lung cancer, using video-assisted surgery. The operation begins with removing certain lymph nodes that are located at the back of the area where the windpipe splits into the lungs. This makes it easier to see and protect an important nerve that controls the voice box, and facilitates the removal of other nodes near the aorta, the main artery of the body.

The nodes near the windpipe and the aorta need to be carefully separated from the upper left lung, while preserving their main lymphatic drainage pathways - the routes through which fluid drains from the lung tissue. It’s crucial not to cut the pathways that drain towards the nodes near the windpipe or those that drain towards the nodes near the aorta.

By following these steps, the upper left portion of the lung and the nearby lymph nodes can be removed in one piece, without cutting their lymphatic connections. We believe this approach can help prevent the spread of cancer cells into the chest cavity, and also reduces the risk of accidentally leaving behind any cancerous lymph nodes.

FAQs

  1. What is the recommended starting point for the en bloc resection procedure?
  2. What precautions should be taken during the dissection of the lower paratracheal nodes and aorto-pulmonary nodes?
  3. How does the en bloc resection procedure help in preventing pleural dissemination and missing any metastatic lymph nodes?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung resection is to ensure they follow all pre-operative instructions provided by their healthcare team, such as fasting before surgery and stopping certain medications as directed. It is also important for the patient to discuss any concerns or questions they may have with their healthcare provider before the procedure. After surgery, the patient should closely follow post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and following any physical therapy or rehabilitation plans to aid in recovery.

Suitable For

Patients with primary lung cancer who are recommended for lung resection typically include those with early-stage non-small cell lung cancer, such as stage I or II disease. These patients may have a solitary tumor in the lung that is localized and has not spread to other parts of the body. Additionally, patients with certain types of lung cancer, such as adenocarcinoma or squamous cell carcinoma, may be candidates for lung resection.

Other patients who may be recommended for lung resection include those with benign lung tumors, such as pulmonary nodules or lung abscesses, that are causing symptoms or complications. Patients with certain lung infections, such as tuberculosis or fungal infections, may also benefit from lung resection in order to remove the infected tissue and prevent further spread of the infection.

Overall, patients who are in good overall health and have adequate lung function are typically considered for lung resection. It is important for patients to discuss the potential risks and benefits of lung resection with their healthcare provider in order to determine if this procedure is the best treatment option for their specific condition.

Timeline

Before lung resection:

  • Patient will undergo a series of tests and imaging studies to confirm the diagnosis of primary lung cancer.
  • Patient will meet with their healthcare team to discuss the treatment options, including the possibility of lung resection.
  • If lung resection is deemed necessary, the patient will undergo pre-operative preparation, which may include blood tests, chest x-rays, and other tests to assess their overall health and fitness for surgery.

After lung resection:

  • The patient will be closely monitored in the intensive care unit or a specialized recovery unit immediately after surgery.
  • The patient will receive pain medication and other supportive care to help manage post-operative pain and discomfort.
  • The healthcare team will closely monitor the patient for any complications, such as infection or bleeding, and provide appropriate treatment if necessary.
  • The patient will undergo physical therapy and breathing exercises to help improve lung function and aid in recovery.
  • The patient will have follow-up appointments with their healthcare team to monitor their progress and discuss any further treatment or rehabilitation needs.

What to Ask Your Doctor

  1. What is the reason for recommending a lung resection in my case?
  2. What are the potential risks and complications associated with a lung resection surgery?
  3. How long will the recovery process take and what can I expect during the recovery period?
  4. Will I need any additional treatments or therapies after the lung resection?
  5. How will the lung resection impact my lung function and overall quality of life?
  6. Are there any specific lifestyle changes or precautions I should take after the surgery?
  7. How experienced are you in performing lung resection surgeries and what is your success rate?
  8. Are there any alternative treatment options available for my condition besides lung resection?
  9. What follow-up appointments or tests will be necessary after the surgery?
  10. Are there any specific instructions or guidelines I should follow before the surgery to prepare?

Reference

Authors: Ueda K, Aoki M, Maeda K, Umehara T, Kariatsumari K, Harada-Takeda A, Nagata T, Yokomakura N, Sato M. Journal: Multimed Man Cardiothorac Surg. 2019 Nov 5;2019:aheadofprint. doi: 10.1510/mmcts.2020.015. PMID: 31751005